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Biomedical subjects

D H Frank

Publications and source records attributed to D H Frank.

At least 19 recordsLinked to original sources
PubMed1992

Subclinical infection of the silicone breast implant surface as a possible cause of capsular contracture.

In order to reexamine the possible association between bacterial presence and capsular contracture, 55 silicone devices (mammary implants or tissue expanders) were cultured at the time of their removal from 40 patients. Special culture techniques were used in an attempt to recover bacteria adhering to the smooth-surfaced implant and encased in glycocalyx biofilm. Bacteria were detected on 56% (15 of 27) of implants surrounded by contracted capsules and on 18% (5 of 28) of those without capsular contracture (p less than 0.05). Only three implants tested positive using routine plating techniques. The predominant isolate was Staphylococcus epidermidis. The concept that capsular contracture is associated with subclinical infection of silicone implants is supported by this study. With changes in the microbiological technique, bacterial recovery and growth occurs at a frequency greater than previously thought.

Adult↗
PubMed1991

Human antibody response following multiple injections of bovine collagen.

The enzyme-linked immunosorbent assay (ELISA) was selected to further characterize the human antibody response to Zyderm (ZCI). Our studies have involved both patients and volunteers. Five patients with delayed cutaneous hypersensitivity reactions to Zyderm were positive for anti-Zyderm antibody. Six of nine patients treated with Zyderm who never displayed cutaneous reactions did develop significant levels of anti-Zyderm serum antibody. Some of these patients progressively increased their antibody levels. None of the volunteers who received multiple skin-test doses (0.1 cc) of Zyderm developed significant levels of anti-Zyderm antibody. Polyvalent anti-Zyderm antibody titers among patients with positive ELISA absorbance ranged from 1:16 to greater than 1:128. All were positive for antibodies of the IgG subtype; half were positive for the IgA subtype. None was positive for IgM or IgE subtype. We did not observe cross-reactivity between patient anti-bovine collagen sera and commercially prepared antibodies to human anti-collagen types I, II, and III. Given the frequency of current Zyderm use, it seems evident that for most patients, biologic exposure to collagen does not pose a health hazard. Nevertheless, because of the scarcity of data pertaining to the long-term significance of humoral anti-Zyderm antibodies, physicians and patients should be aware that unanswered questions remain whenever clinical use of injectable collagen is recommended.

Animals↗
PubMed1991

Reconstitution of the histologic characteristics of a giant congenital nevomelanocytic nevus employing the athymic mouse and a cultured skin substitute.

This study addresses the development of an animal model for human giant congenital nevomelanocytic nevi (GCNN). Skin grafts were made from 1) non-involved split-thickness skin from a 12-month-old GCNN patient, 2) nevus split-thickness skin from the same GCNN patient, 3) nevus full-thickness skin, and 4) cadaveric human split-thickness skin. For groups 1) and 2), human epidermal and dermal cells were enzymatically isolated and expanded in tissue culture. Composite grafts were made by placing the cultured dermal cells into a collagen-glycosaminoglycan (GAG) matrix, followed by placement of the epidermal cells onto the opposite, laminated side of the matrix. All grafts were placed onto full-thickness wounds of athymic mice and biopsies were obtained from 6 to 38 weeks later for light microscopy including S-100 immunoperoxidase staining, and electron microscopy. The GCNN cultured skin mice (group 2) developed black, raised skin in the healed wounds. None of the group 1 mice developed lesions, grossly or histologically. All of the nevus full-thickness mice retained the nevus grossly. Histopathologic examination at 38 weeks of the black, raised plaques of group 2 demonstrated a reconstituted dermis similar to group 3. Nevus cells were larger and more epithelioid in the upper dermis, as seen with true GCNN. These nevomelanocytes were not seen in the dermis at 24 weeks, suggesting that the nevus cells migrated from the epidermal component of the cultured graft to the dermis during this time frame (24-38 weeks). The melanocyte identity of these cells was confirmed with S-100 immunoperoxidase staining and electron microscopy. These findings are unique to this composite cultured graft system. The ability to culture specific types of melanocytes and place them int skin substitutes on athymic mice provides a basis for the study of GCNN and melanocyte biology in vivo.

Animals↗
PubMed1990

Cytotoxicity to cultured human keratinocytes of topical antimicrobial agents.

Cultured skin grafts administered clinically for closure of burn wounds may be contacted by topically applied antimicrobial agents. A study was performed to assess whether commonly used topical antimicrobial agents are toxic to cultured human keratinocytes (HK) in vitro. Serum-free MCDB 153 culture medium containing Neosporin G.U. irrigant (Neomycin, 40 micrograms/ml-polymyxin B sulfate, 200 units/ml) and a standard tissue culture antimicrobial agent of penicillin (10,000 units/ml)-streptomycin (10,000 micrograms/ml)-amphotericin B (25 micrograms/ml) had no effect on the keratinocyte growth rates when compared to standard MCDB 153 medium without antibiotics. Medium containing Sulfamylon (mafenide acetate, 0.85%), Polysporin (polymyxin B sulfate, 1 x 10(4) units/ml-bacitracin, 500 units/ml), gentamicin sulfate (0.1%), modified Dakins solution (25%), and acetic acid (0.25%) all showed statistically significant (P less than 0.01) decreases in keratinocyte growth rates. This data suggests that commonly applied antimicrobials may not be appropriate for cultured grafts in the concentrations that are used clinically.

Acetates↗
PubMed1986

B-mode ultrasonic echo determination of depth of thermal injury.

A high-resolution high-frequency prototype B-mode ultrasonic scanning device was utilized to determine the depth of burn in a pilot study of five burned patients. Comparisons with clinical evaluations and histopathological studies of burn wound biopsies of the same burned areas failed to show any substantive improvement in predicting the depth of burn by ultrasonic scanning techniques. Current ultrasonic scanning is of no practical value to the burn surgeon for differentiating precisely between the depth of a deep dermal burn and a full skin thickness thermal injury.

Adolescent↗
PubMed1986

The scrotal myocutaneous flap.

The scrotum is a thermoregulatory, well-vascularized structure formed by skin and nonstriated muscle with unique elastic properties. This makes it an ideal source of tissue coverage for problem wounds in its vicinity. Two patients in which scrotal musculocutaneous flaps were used are reported: one, a paraplegic, with a recurrent ischioperineal decubitus ulcer, and another with an ulcer of the penis with exposed Dacron graft previously placed to treat Peyronie's disease. After reviewing the anatomy of the scrotum and the existent literature, we studied scrotal vascularity in a fresh specimen by transillumination. Based on our experience, we conclude that this flap is easy to perform, reliable, and very useful for wounds around the perineal region.

Adult↗
PubMed1985

Inhibition of wound contraction: comparison of full-thickness skin grafts, Biobrane, and aspartate membranes.

The mechanism by which open wounds contract is unknown. Although myofibroblasts are implicated in this natural process of wound healing, the evidence, however convincing, is only circumstantial. Control of wound contraction has been sought for many years, but only the application of full-thickness skin grafts is able to produce safe and effective clinical results. By comparing the synthetic skin substitute Biobrane and its component parts with full-thickness skin grafts in a rat wound model, we have demonstrated that dermis is not required for inhibition of wound contraction. We postulate that physical properties of skin and its synthetic analogues, including adherence to the wound surface, may be the signals to the open wound that effectively inhibit contraction. Whether myofibroblasts participate in this interaction remains unanswered.

Animals↗
PubMed1985

Objective measurement of hypertrophic burn scar: a preliminary study of tonometry and ultrasonography.

Many people are burned each year and subsequently develop hypertrophic burn scars. An objective means for quantitatively measuring scar characteristics would be useful in monitoring resolution of the individual patient's scars as well as in evaluating different treatment protocols. Two methods for quantitative measurement of hypertrophic scars were evaluated in 4 patients at 8 scar sites over a 2-month period. A specially designed tonometer, the cicatrometer, assesses scar firmness and pliability. It is shown to provide a simple noninvasive means for objectively evaluating the progress of scar maturation and therapy. High-resolution ultrasonic scanning is shown to provide an objective, quantitative measurement of hypertrophic scar thickness, which can be compared between patients. This allows for the design of controlled trials comparing different treatment protocols.

Burns↗
PubMed1984

Decrease in rate of wound contraction with the temporary skin substitute biobrane.

In burn patients normal wound healing contraction may lead to contracture deformity requiring secondary reconstruction. Full-thickness skin grafts are observed to inhibit both contraction and myofibroblasts by an unknown mechanism. The temporary synthetic skin substitute Biobrane has become an acceptable alternative to cadaver allografts for many burn and reconstruction wounds. We have postulated that this synthetic membrane might also share the ability to inhibit wound contraction. By comparing open and Biobrane closed wounds in 20 rats, we have demonstrated a significant (p less than 0.005) difference in wound size during the time that the Biobrane is adherent to the wound. Linear regression curves are used to express the rate of contraction and demonstrate a threefold decrease. Alternative mechanisms for this inhibition are postulated, including mechanical stenting versus direct inhibition of contractile myofibroblasts.

Animals↗
PubMed1983

Historical review of small and microvascular vessel surgery.

The history of small and microvessel surgery is reviewed to aid the beginning microvascular surgeon in gaining a perspective of the surgical techniques used on vessels less than 3 mm in diameter. Although microvascular surgery uses sophisticated microscopes, instruments, and sutures, the fundamental operative procedures are similar to those first worked out on larger vessels. The trial and error methods of past surgeons from many different disciplines have led to ever-expanding possibilities for treatment of sick and injured patients and to laboratory investigation of disease processes. We have tried to highlight the major steps in the development of vascular surgery leading up to our present core of microvascular techniques. We recognize that many of these will become obsolete tomorrow; however, in developing the new it is wise to avoid the mistakes of the past.

Arteriovenous Shunt, Surgical↗
PubMed1983

The early treatment and reconstruction of eyelid burns.

Eyelid burns occurred in 67% of the 210 patients with facial burns admitted to the San Diego Regional Burn Center between 1 December 1977 and 30 June 1982. Evaluation of 48 surviving patients with significant eyelid injury demonstrated the safety and effectiveness of early excision and grafting of eyelid burns. Tarsorrhaphies were found not to be useful in preventing ectropion and resulted in deformity of the lid margins. Our technique employing early excision and grafting and reconstruction of eyelid burns is illustrated.

Adult↗
PubMed1983

Influence of a "discharge interview" on patient knowledge, compliance, and functional status after hospitalization.

Physicians commonly assume that they can educate hospitalized patients to follow prescribed treatment plans after discharge. In a prospective, controlled study, we assessed the effectiveness of a discharge interview given to each of 545 hospitalized patients assigned to one of four groups: a group in which the physicians caring for the patients received a 35-minute tutorial on how to conduct a discharge interview (n = 181), a group that received a 15-minute discharge interview from an investigator (n = 53), a group that received both interventions (n = 63), or a control group (n = 248). One month after discharge, all patients were telephoned, and a standardized questionnaire was administered. Results revealed that, 1 month after discharge, there were no significant differences among the four groups in knowledge of diagnosis, symptom status, activity level, medication knowledge and compliance, appointment keeping, and rates of rehospitalization. These results suggest that effective inpatient education may require more than a discharge interview.

Evaluation Studies as Topic↗
PubMed1982

Accidental hypothermia treated with rapid rewarming by immersion.

Eighteen consecutive hypothermia patients were treated with rapid rewarming by immersion. Continous electrocardiographic monitoring, acid-base and central venous pressure measurements, vital signs, and fluid resuscitation with lactated Ringer's solution (tritrated to urine output) were employed as part of the therapeutic regimen. This regimen was associated with a single mortality. Rapid rewarming by immersion appears to be a safe, effective, and relatively simple method for treating accidental hypothermia victims.

Acid-Base Equilibrium↗
PubMed1980

Osteomyelitis of the skull following scalp reduction and hair plug transplantation.

A case of Staphylococcus aureus osteomyelitis of the skull following scalp reduction and hair plug transplantation is presented. Frontal and biparietal craniectomies were performed, adjacent galea and subcutaneous tissues were excised, and intravenous antibiotics were administered to eradicate the infection and forestall the development of sagittal sinus thrombosis. Persistent drainage of hair plug transplantation sites may suggest underlying osteomyelitis.

Hair↗